– Memory from 6 years ago when I was a medical officer in the Anaesthesia Department –
Being a doctor in a major tertiary hospital means I have to be on call for at least 24 hours per oncall shift. I could not help from feeling that starting an on-call in ICU is akin to receive Hari Raya’s angpow. The feeling of “You never know whachu gonna get”. I may end up with only 10 patients to look after or the full ’20 bed’ situation.
The passing over session is always the crucial bit. My colleague who is on-call the night before will go through all the ICU cases with the one who is taking over that day AKA yours truly.
A typical pass over case is something like this: “Mr James Bond is a 40 year old English chap who’s admitted 8 hours ago for a gun-shot wound to the left upper chest causing left tension haemopneumothorax. GCS on arrival was 6/15. Intubated in Emergency room with ETT 7.5mm @ 20cm under midazolam 3mg and suxa 100mg IV. Chest tube was inserted uneventfully in ED. The bullet was surgically removed 1 hour ago in the OR. Blood loss 300cc. Haemodyamics stable bla bla..”
When reviewing patients, I would usually break down the problem list into systems i.e ventilation, haemodynamics, infection. That helps me to focus on specific problems or anticipate any future complications. Then I would go through the OT list — cases need to be operated on. The secret of surviving this is always know HOW TO PRIORITISE. Look at your little note book (like the one at the top and start juggle your cases)
Hmm… At times before I start my oncall, I would ask myself in my Clint Eastwood’s deep husky voice:
“Ask yourself this. Do u feel lucky today ? Well do u punk??”
Heartpill 